| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
784 |
551 |
$238K |
| D1110 |
Prophylaxis - adult |
3,893 |
3,859 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,498 |
3,473 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,128 |
714 |
$30K |
| D2954 |
|
429 |
306 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,993 |
1,978 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
981 |
948 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,751 |
3,094 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,079 |
1,052 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,978 |
1,961 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
354 |
153 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,892 |
1,161 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
161 |
160 |
$2K |
| D3320 |
|
14 |
13 |
$2K |
| D0160 |
|
157 |
149 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$408.00 |
| D9430 |
|
102 |
101 |
$348.74 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$180.00 |
| D9310 |
|
100 |
94 |
$100.00 |